Search Results (344)

Introduction: Adolescents and young adults (AYAs), especially those from underserved communities, often face barriers to sexual and reproductive health (SRH). This pilot study evaluated the implementation of mobile health technologies to promote SRH care, including the integration of the Rapid Adolescent Prevention Screening^TM (RAAPS) and the Health-E You/Salud iTu^TM (Health-E You) app at a School-Based Health Center (SBHC) in Los Angeles using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Methods: This multi-method pilot study included the implementation of an integrated tool with two components, the RAAPS electronic health screening tool and the Health-E You app, which delivers tailored SRH education and contraceptive decision support to patients (who were sex-assigned as female at birth) and provides an electronic summary to clinicians to better prepare them for the visit with their patient. Quantitative data on tool usage were collected directly from the back-end data storage for the apps, and qualitative data were obtained through semi-structured interviews and in-clinic observations. Thematic analysis was conducted to identify implementation barriers and facilitators. Results: Between April 2024 and June 2024, 60 unique patients (14–19 years of age) had a healthcare visit. Of these, 35.00% used the integrated RAAPS/Health-E You app, and 88.33% completed the Health-E You app only. All five clinic staff were interviewed and expressed that they valued the tools for their educational impact, noting that they enhanced SRH discussions and helped uncover sensitive information that students might not disclose face-to-face. However, the tools affected clinic workflows and caused rooming delays due to the time-intensive setup process and lack of integration with the clinic’s primary electronic medical record system. In addition, they also reported that the time to complete the screener and app within the context of a 30-min appointment limited the time available for direct patient care. Additionally, staff reported that some students struggled with the two-step process and did not complete all components of the tool. Despite these challenges, clinic staff strongly supported renewing the RAAPS license and continued use of the Health-E You app, emphasizing the platform’s potential for improving SRH care and its educational value. Conclusions: The integrated RAAPS and Health-E You app platform demonstrated educational value and improved SRH care but faced operational and technical barriers in implementing the tool. These findings emphasize the potential of such tools to address SRH disparities among vulnerable AYAs while providing a framework for future implementations in SBHCs. Full article

Shift work can have an adverse impact on sleep and wellbeing, as well as negative consequences for workplace safety and productivity. SleepShifters is a co-developed sleep management programme that aims to equip shift workers and employers with the skills needed to manage sleep from the onset of employment, thus preventing sleep problems and their associated consequences from arising. This paper describes the co-development process and resulting programme protocol of SleepShifters, designed in line with the Medical Research Council’s framework for the development and evaluation of complex interventions. Programme components were co-produced in partnership with stakeholders from four organisations across the United Kingdom, following an iterative, four-stage process based on focus groups and interviews. As well as a handbook containing guidance on shift scheduling, workplace lighting, and controlled rest periods, SleepShifters consists of five key components: (1) an annual sleep awareness event; (2) a digital sleep training induction module for new starters; (3) a monthly-themed sleep awareness campaign; (4) a website, hosting a digital Cognitive Behavioural Therapy for insomnia platform and supportive video case studies from shift-working peers; (5) a sleep scheduling app for employees. Future work will implement and assess the effectiveness of delivering SleepShifters in organisational settings. Full article

Background/Objectives: Children with cancer suffer due to the underlying disease and prescribed cancer-directed therapies, and non-pharmacologic modalities may offer improved symptom control without additional medications. We sought to elicit knowledge, attitudes, and beliefs of Pediatric Hematology Oncology (PHO) providers surrounding the incorporation of acupuncture for symptom management for their patients. Methods: A cross-sectional survey instrument was created, formatted, and delivered to physicians and advanced practice providers (APPs) at a single US pediatric cancer center. Survey responses were summarized by descriptive statistics. Results: A total of 78 PHO clinicians participated (response rate 29%). Most participants were interested in learning more about acupuncture (n = 42, 56.0%), yet rarely (n = 17, 22.7%) or never (n = 46, 61.3%) recommend acupuncture to patients. Most (n = 51, 73.9%) noted that they would support institutional development of an acupuncture program. Over half (n = 37, 52.2%) indicated their threshold for minimum hematologic indices for acupuncture includes a platelet count greater than 20,000 and absolute neutrophil count (ANC) greater than 500 (n = 37, 54.4%). Approximately two-thirds (n = 52, 66.7%) of participants noted that acupuncture could improve their patient’s quality of life, and most (n = 46, 67.6%) were not worried about harm. Conclusions: Acupuncture for symptom management is an evidenced-based, guideline-concordant recommendation for adults with cancer, but robust data in the pediatric oncology population are lacking. PHO providers do not routinely recommend acupuncture for patients but note that it may improve quality of life. Given their high symptom burden, rigorous studies of non-pharmacologic strategies for pediatric symptom management are vital. Acupuncture should be examined as a potential beneficial adjunct. Full article

Background/Objectives: Breast milk donation is increasingly recognized as a vital public health resource, providing optimal nutrition for infants who cannot be breastfed by their biological mothers. Human milk banks play a crucial role in supporting infant health, particularly for preterm and medically vulnerable infants. Despite its recognized benefits, the practice of breast milk donation and utilization remains influenced by a complex interplay of individual, social, and cultural factors. Methods: This study systematically examines how demographic and sociocultural variables are associated with attitudes and behaviors related to breast milk donation. Data were collected from 1223 Israeli mothers via questionnaires distributed through WhatsApp groups between April and May 2025. By analyzing the questionnaire results, the research identified key predictors of willingness to donate and use donated milk, as well as patterns of awareness and perceived support within different population groups. Results: Higher education (χ² = 12.87, p = 0.0016) and settlement type (χ² = 83.096, p = 0.000) were significantly associated with greater willingness to donate breast milk. Income level had no effect on donation behavior, though higher-income participants were more open to its use (χ² = 86.838, p = 0.000). Lifestyle also influenced perceptions of social support (F(2, 1220) = 259.4036, p < 0.001) and cultural support (F(2, 1220) = 601.2383, p < 0.001) of milk donation and use. Significant correlation was found between perceived cultural and social support (t = 5.140, p = 0.000), emphasizing their interrelated influence on milk donation attitudes. Conclusions: The findings assist in guiding the development of public health policies, as well as targeted awareness campaigns, to promote equitable access to donor milk services across varied communities. From the public health perspective, the findings of this study can orientate campaigns that encourage both donation and use of breast milk focusing on segments of the population in which the level of awareness is relatively low. Full article

Background/Objectives: This study aimed to evaluate a regional implementation project for rural emergency care (RuralRescue) and to examine how its components and outcomes may support personalized approaches in emergency medicine. While not originally designed as a personalized medicine intervention, the project combined digital, educational, and organizational innovations that enable patient-specific adaptation of care processes. Methods: Conducted in the rural district of Vorpommern-Greifswald (Mecklenburg–Western Pomerania, Germany), the intervention included (1) standardized cardiopulmonary resuscitation (CPR) training for laypersons, (2) a geolocation-based first responder app for medically trained volunteers, and (3) integration of a tele-emergency physician (TEP) system with prehospital emergency medical services (EMSs). A multi-perspective pre–post evaluation covered medical, economic, and organizational dimensions. Primary and secondary outcomes included bystander CPR rates, responder arrival times, telemedical triage decisions, diagnostic concordance, hospital transport avoidance, economic simulations, workload, and technology acceptance. Results: Over 12,600 citizens were trained in CPR and the responder app supported early intervention in hundreds of cases. TEPs remotely assisted 3611 emergency calls, including delegated medication in 17.8% and hospital transport avoidance in 24.3% of cases. Return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) was achieved in 35.6% of cases with early CPR. Diagnostic concordance reached 84.9%, and documentation completeness 92%. Centralized coordination of TEP units reduced implementation costs by over 90%. Psychological evaluation indicated variable digital acceptance by role and experience. Conclusions: RuralRescue demonstrates that digitally supported, context-aware, and regionally integrated emergency care models can contribute significantly to personalized emergency medicine and can be cost-effective. The project highlights how intervention intensity, responder deployment, and treatment decisions can be tailored to patient needs, professional capacity, and regional structures—even in resource-limited rural areas. Full article

The growing influence of technology in the healthcare industry has led to the creation of innovative applications that improve convenience, accessibility, and diagnostic accuracy. However, health applications face significant challenges concerning user privacy and data security, as they handle extremely sensitive personal and medical information. Privacy-Enhancing Technologies (PETs), such as Privacy-Attribute-based Credentials, Differential Privacy, and Federated Learning, have emerged as crucial tools to tackle these challenges. Despite their potential, PETs are not widely utilized due to technical and implementation obstacles. This research introduces a comprehensive framework for protecting health applications from privacy and security threats, with a specific emphasis on gamified mental health apps designed to manage Attention Deficit Hyperactivity Disorder (ADHD) in children. Acknowledging the heightened sensitivity of mental health data, especially in applications for children, our framework prioritizes user-centered design and strong privacy measures. We suggest an identity management system based on blockchain technology to ensure secure and transparent credential management and incorporate Federated Learning to enable privacy-preserving AI-driven predictions. These advancements ensure compliance with data protection regulations, like GDPR, while meeting the needs of various stakeholders, including children, parents, educators, and healthcare professionals. Full article

Background/Objectives: Effective communication between healthcare professionals and patient caregivers is paramount in the surgical waiting area, particularly during periods of heightened stress and emotional vulnerability. Globally, communication practices exhibit considerable variability, from traditional face-to-face interactions to integrating advanced digital technologies. Despite innovations, a comprehensive understanding of the impact of diverse communication strategies on patient caregiver satisfaction remains underdeveloped. This scoping review was designed to systematically map the existing literature on healthcare communication practices and identify strategies that may influence satisfaction among patient caregivers. Methods: A thorough search of multiple databases—Scopus, PubMed, CINAHL, Embase, ProQuest, Web of Science, the Cochrane Library, and clinical trial registries—was conducted. Only studies published in English or those for which an English full text was accessible were included. Eligible studies were those undertaken in hospital settings, including operating theaters, surgical units, surgical waiting areas, postoperative intensive care units, emergency departments, and other clinical areas focusing on patient caregivers. The review adhered to the methodological framework recommended by the Joanna Briggs Institute for scoping reviews and was reported following the most recent PRISMA-ScR guidelines. Results: Ultimately, five studies met the inclusion criteria. The selection process involved a structured search utilizing Medical Subject Headings (MeSH), keywords, and index terms, supplemented by manual reference list screening. Initial screening was performed based on titles and abstracts, followed by full-text evaluation using a standardized selection form. Data extraction focused on the communication methods, study designs, and outcomes related to patient caregiver satisfaction. The findings are synthesized narratively and presented through tables and figures, offering a comprehensive overview of global communication practices and their influence on patient caregiver satisfaction in surgical environments. Across the five included studies, digital communication interventions such as SMS, mobile apps, or video updates reported improved patient caregiver satisfaction (e.g., 70.8% in Canada and 97% in Switzerland) and also reduced patient caregiver anxiety (e.g., STAI score ≥ 44) in 74.2% of Ethiopian patient caregivers. Worldwide evidence highlights the practical importance of tailored digital communication practices to support providing timely and accessible information to patient caregivers, while also revealing gaps linked to insurance status, digital literacy, and various communication approaches in healthcare systems. Conclusions: The five studies included showed considerable variation in communication practices across surgical settings. The main findings reveal that structured, timely, and transparent communication, mainly via digital tools such as SMS updates and mobile applications, enhanced patient caregiver satisfaction and alleviated their emotional distress too. Nevertheless, gaps were identified in postoperative communication, and challenges, such as technological accessibility, digital literacy skills of patient caregivers, and inconsistent methods for measuring satisfaction outcomes, were noted across studies. This scoping review identified the different types of healthcare communication practices adopted globally in surgical care settings and also demonstrated their influence on patient caregiver satisfaction. Traditional and digital communication practices both have their significant impact on patient caregiver experiences in surgical healthcare settings, focusing more on timely and consistent real-time updates and culturally sensitive information. Addressing the existing communication gaps and having tailored communication approaches to specific contexts may lead to improved patient caregiver support and surgical outcomes. Full article

Introduction: The rapid growth of mobile health (mHealth) applications has revolutionized healthcare delivery worldwide. These digital tools encompass a broad array of functionalities, including telemedicine, appointment scheduling, medication management, and health data tracking, all of which contribute to enhanced healthcare accessibility, increased patient engagement, and improved operational efficiency. However, despite their increasing prominence, the design, deployment, and use of mHealth applications continue to face several challenges, such as usability issues and overall sustained adoption. Objectives: This study aims to evaluate mHealth applications in Saudi Arabia, focusing on their design characteristics, usability features, and current feature gaps. Method: A total of 21 mHealth applications were selected and analyzed using a thematic analysis approach. The apps were selected based on usage popularity in the Saudi market and relevance to national digital health strategies. Data were drawn from publicly available app store information, official app documentation, and expert evaluations. Results: The findings reveal that while mHealth applications excel in areas such as telemedicine, appointment booking, and health education, there are notable gaps in features such as behavior modification, patient monitoring, and health management. Conclusions: This study contributes to the growing body of research on mHealth by offering grounded insights into the functional landscape of digital health tools in Saudi Arabia. It also outlines practical recommendations to enhance usability, feature diversity, and alignment with evolving healthcare needs in Saudi Arabia and beyond. Full article

Chronic disease self-management (CDSM) is critical for improving health outcomes, particularly for individuals with low health literacy who face barriers in accessing and understanding medical information. This study examined the role of tailored digital health interventions in reducing stress and improving quality of life among individuals with chronic conditions. A multisite randomized controlled trial including 309 participants at baseline aged 40 to 90 years was conducted using a mobile app that provided self-management information at different literacy levels. Latent growth curve modeling (LGM) computed in Mplus was used to assess changes in stress over time and its impact on quality of life. The results indicated that successful tailoring of health information was significantly associated with reductions in perceived stress, which, in turn, predicted improvements in quality of life. These findings suggest that personalized digital interventions may enhance engagement with self-management strategies, alleviate psychological distress, and contribute to better overall well-being. This study highlights the importance of tailoring health content to users’ literacy levels and informational needs, underscoring the potential of mobile health solutions for improving CDSM. Future research should explore additional mechanisms underlying these effects and assess the long-term sustainability of digital interventions in diverse populations. These results provide valuable insights into optimizing mobile health applications to support individuals with chronic conditions. Full article

Background/Objectives: Potassium-competitive acid blockers (P-CABs) offer rapid gastric acid inhibition and lower toxicity compared to proton pump inhibitors (PPIs). This study investigates the drug–drug interaction between P-CABs and immunosuppressants tacrolimus and mycophenolate in kidney transplant recipients (KTRs). Methods: Sixty-two KTRs were randomized to receive either 50 mg of tegoprazan or 20 mg of pantoprazole. Patients were monitored using a smart clinical trial platform incorporating remote monitoring and safety management systems, which tracked drug adherence and vital signs. General and gastrointestinal (GI) symptoms were surveyed via a self-developed app on patients’ phones. Trough levels of tacrolimus and mycophenolate were measured every 4 weeks over 12 weeks. Results: Medication adherence was 100% in both groups. A total of 13,726 biometric data points and 5031 questionnaire responses were collected, with 5704 feedback messages and 56 video visits conducted. At 12 weeks, the mean trough levels of tacrolimus and mycophenolate were similar between the tegoprazan and pantoprazole groups (5.5 ± 1.6 vs. 5.8 ± 2.0 ng/mL, p = 0.50 and 2.7 ± 1.4 vs. 2.6 ± 1.4 µg/mL, p = 0.57, respectively). The intragroup difference in trough levels from baseline to week 12 was not significant in either group. GI symptoms scores, vital signs, and allograft function remained stable and comparable between groups. Conclusions: Tegoprazan does not alter the blood trough levels of tacrolimus and mycophenolate during the 12-week follow-up in KTRs and has a similar impact on GI symptoms as pantoprazole. This study confirms the feasibility and safety of using a smart clinical trial system with remote monitoring for randomized trials. Full article

Iron accumulation in the brain is widespread in Alzheimer’s disease (AD), the most common cause of dementia. According to numerous studies, too much iron triggers the development of neurofibrillary tangles (NFTs) and amyloid-β (Aβ) plaques, both of which accelerate the onset of AD. Iron sequestration and storage were disrupted by high iron, and the pattern of interaction between iron regulatory proteins (IRPs) and iron-responsive elements (IREs) was altered. The 5′-untranslated regions (5′-UTRs) of their APP mRNA transcripts have an IRE stem-loop, which is where iron influx enhances the translation of the amyloid precursor protein (APP). Iron regulated APP expression via the release of the repressor interaction of APP mRNA with IRP1 by a pathway similar to the iron control translation of the ferritin mRNA by the IREs in their 5′-UTRs. This leads to an uncontrolled buildup of redox active Fe²⁺, which exacerbates neurotoxic oxidative stress and neuronal death. Fe²⁺ overload upregulates the APP expression and increases the cleavage of APP and the accumulation of Aβ in the brain. The level of APP and Aβ, and protein aggregates, can be downregulated by IRPs, but are upregulated in the presence of iron overload. Therefore, the inhibition of the IRE-modulated expression of APP or Fe²⁺ chelation offers therapeutic significance to AD. In this article, I discuss the structural and functional features of IRE in the 5′-UTR of APP mRNA in relation to the cellular Fe²⁺ level, and the link between iron and AD through the amyloid translational mechanism. Although there are currently no treatments for AD, a progressive neurodegenerative disease, there are a number of promising RNA inhibitor and Fe²⁺ chelating agent therapeutic candidates that have been discovered and are being validated in April 2025 clinical trials. Future studies are expected to further show the therapeutic efficacy of iron-chelating medications, which target the APP 5′-UTR and have the ability to lower APP translation and, consequently, Aβ levels. As a result, these molecules have a great deal of promise for the development of small-molecule RNA inhibitors for the treatment of AD. Full article

Child and adolescent obesity represents a growing public health crisis, with profound implications for physical and mental well-being. Despite the well-established benefits of physical activity, over 80% of adolescents fail to meet the World Health Organization’s (WHO) recommendations for daily exercise. This manuscript explores gym-based strength training as a tailored intervention for obese youth who often struggle with aerobic activities. This paper critically examines medical eligibility, safety protocols, and injury risks while also detailing personalized training regimens that prioritize neuromuscular adaptation, functional strength, and long-term engagement. Additionally, it integrates evidence-based dietary strategies and supplementation practices appropriate for this age group, highlighting the role of the Mediterranean diet, DASH, and the cautious use of supplementation, particularly probiotics and protein, while discouraging performance-enhancing substances in youth. Emphasis is placed on interdisciplinary approaches, combining exercise, nutrition, and medical oversight to support holistic treatment. This study identifies gaps in the current literature and provides practical recommendations for designing safe, effective, and sustainable gym-based interventions for children with obesity, encouraging further research to validate these protocols in clinical settings. A comprehensive search was conducted across multiple databases, including PubMed/MEDLINE, the Cochrane Library, Science Direct, and EBSCO, focusing on English-language meta-analyses, systematic reviews, randomized clinical trials, and observational studies. The websites of prominent scientific organizations such as WHO, APP, and AIS were also reviewed. The selection of articles was a collaborative effort among all authors. Full article

The objective was to evaluate the growth in pharmacy student performance in entrustable professional activity (EPA) assessments across the experiential curriculum based on preceptor assessments on an entrustment–supervision (ES) scale. This retrospective cohort study used assessments based on the 2016 American Association of Colleges of Pharmacy Core EPAs and an expanded ES scale during introductory and advanced pharmacy practice experiences (IPPEs/APPEs) in the third and fourth professional years from fall 2020 to fall 2023. The primary outcome was the change in ES level, assessed by preceptors over time. The secondary outcomes were growth rates across types of experiences, training environments, and experience order. A conditional growth curve model and ordinal mixed effects model were used to demonstrate discrete entrustment decisions. A total of 509 students received 12,426 assessments by 557 preceptors. Raw ES levels and unconditional growth curves for EPA show increases in entrustability from years P3 to P4. Comparing care settings, there was lower entrustment in inpatient than outpatient settings and at academic medical centers than other settings. There were no significant differences in ES levels regardless of which IPPE was taken first. However, when the first APPE was an inpatient medicine experience, ES levels across APPEs for EPA 3 were higher when compared to ambulatory care as the first APPE, and they were higher for EPA 5 when compared to community pharmacy as the first APPE. Paired with ES scales, EPAs can be integrated into pharmacy experiential curricula to demonstrate longitudinal growth in student entrustment. Full article

Background: Mobile health (mHealth) applications play a crucial role in enhancing healthcare accessibility, patient engagement, and chronic disease management. However, technical, usability, accessibility, and privacy-related barriers continue to hinder their widespread adoption. The Sehaty app, a government-managed mHealth platform in Saudi Arabia, is widely used for scheduling medical appointments, accessing health records, and communicating with healthcare providers. Understanding the challenges associated with its utilization is essential for optimizing its functionality and improving user experience. Aim: This study aims to identify and evaluate the key barriers affecting the adoption and usability of the Sehaty mHealth application among patients with chronic conditions in Saudi Arabia. Specifically, it examines challenges related to technical performance, usability, accessibility, privacy, and security and their impact on user satisfaction and engagement. Methods: A cross-sectional study was conducted using a structured questionnaire distributed to 344 participants selected through purposive sampling to ensure the inclusion of active Sehaty users with chronic conditions. The questionnaire assessed 10 primary usability barriers, including technical issues, navigation difficulties, privacy concerns, and accessibility limitations. Descriptive statistics and correlation analyses were performed to evaluate the prevalence and interrelationships of these barriers. Results: The findings indicate that technical barriers, including frequent application crashes, slow responsiveness, and system instability, significantly hinder user satisfaction. Usability challenges, such as difficulties in navigation and task completion, further impede engagement. Moreover, privacy and security concerns emerged as significant deterrents, with users expressing apprehensions about data safety and transparency. Accessibility barriers, particularly for older adults and individuals with disabilities, were associated with insufficient support and training, making the app less user-friendly for these populations. The study highlights the interconnected nature of usability challenges, suggesting that improvements in technical stability and interface design could lead to enhanced user confidence, engagement, and overall satisfaction. Conclusions: Addressing these barriers requires targeted technical enhancements, user-centered design improvements, and strengthened data security measures to promote trust and engagement. Additionally, implementing comprehensive user support systems and accessibility features is essential to ensuring equitable access to mHealth services. While the study’s generalizability is limited by its focus on a single government-managed platform, its findings offer valuable insights applicable to broader mHealth initiatives. Future research should incorporate longitudinal studies to assess the long-term impact of usability improvements on mHealth adoption and healthcare outcomes. Full article

Aim: Mobile health (mHealth) applications have been reported to be effective in improving glycaemic control and cardiometabolic health, but mainly as part of shorter-term intervention studies. The aim of this study is to examine the effect of the ongoing Defeat Diabetes mHealth low-carbohydrate diet (LCD) intervention on clinical markers and cardiometabolic risk after 6 months of intervention. Methods: Data were collected via primary care physicians as part of routine T2D monitoring. These included HbA1c (primary outcome), blood pressure, blood lipids, and markers of kidney and liver function. Anthropometrics, as well as changes in the prescription of diabetes, hypertension, and dyslipidaemia medication, were also recorded. Calculated variables, total cholesterol to HDL-c, triglyceride to HDL-c, and waist to height ratios, were analysed to examine changes in cardiometabolic risk profile. Three-day food records were used to assess dietary intake and intervention adherence. Univariate regression models examined changes from baseline to 6 months. Results: Ninety-four participants remained in the study out of the ninety-nine at baseline (mean age 59 ± 11 years, 55 females). After 6 months of intervention, there were significant reductions in HbA1c by −1.0% (95% CI: −1.3 to −0.6), as well as in the liver enzymes ALT (−9.3 U/L 95% CI −16.3 to −2.4) and GGT (−18.8 U/L 95% CI: −31.4 to −6.3) across the cohort. In addition, there was a significant reduction in cardiometabolic risk, as measured by the calculated variables and a decrease in waist circumference (−4.6 cm 95% CI: −8.9 to −0.2). Conclusions: People with T2D receiving LCD education and resources through the Defeat Diabetes mHealth app (version 3.3.8) improved their glycaemic control after 6 months of intervention. Cardiometabolic risk profile and liver function also showed significant improvement. These findings indicate that the use of an LCD digital app is a valuable adjunct in the management of T2D. Full article